What You Should Know About Insurance Coverage and Eating Disorder Treatment

Article Contributed by Rachel Teicher, B.A. in Psychology – Kantor & Kantor, LLP

a mother and child fighting for Insurance CoverageThe Road Ahead

Recovering from an eating disorder is no easy task. The journey is a multilayered and complicated one – full of change, learning, hardships, and setbacks – but absolutely worth every step. In addition to working towards recovery, you might find yourself battling your insurance company for insurance coverage after a denial or an early discharge from treatment.

Unfortunately, fighting for your life in recovery, and fighting with your insurance company for access to treatment, often goes hand in hand.

These types of tragic insurance denials happen every single day. Often this treatment is essential to the wellbeing – and even survival of the eating disorder sufferer. This treatment is medically necessary in order to recover from one of the deadliest of all mental illnesses.

Unfortunately, even with this urgent need, insurance companies continue to circumvent the law, violate mental health parity, and deny access to life-saving treatment.

5 Tips For Insurance Coverage

Advocating for insurance coverage for the treatment of an eating disorder can be confusing and complicated. Here are several important things for you to know:

  • Request a copy of your insurance policy before going into treatment. Without a copy of the policy, you do not know the rules, and legal counsel cannot assist you in determining what your benefits are. Request a copy from your employer or the insurance company and become familiar with it. They are required to give you a complete copy upon your request.
  • Once in treatment, stay in treatment! Even after receiving an insurance denial, YOU MUST STAY IN TREATMENT IN ORDER TO PURSUE LEGAL ACTION. Not everyone knows or remembers this piece – but it is incredibly important. Under ERISA (Employee Retirement Income Security Act), we cannot pursue legal action without being able to prove that you lost benefits. The only way you will have unpaid benefits is if you stay in treatment and pay out of pocket, or owe money to the treatment facility.
  • Follow the advice and recommendations of the treatment team….not the insurance company. Do not let the insurance company dictate your recovery! The cost of treatment is incredibly costly, and some families must go to extreme measures to keep a loved one in treatment. This can be a frightening and chaotic time for the sufferer and family members.It may be helpful to have an attorney work with your insurance company and treatment facility after a denial to seek reimbursement of the benefits available under your policy. If your insurance denies coverage for treatment, legal counsel can only help you recover these benefits if you (1) have an insurance denial in writing and (2) have STAYED in treatment.
  • An insurance denial is not the final word. An insurance denial can be incredibly frustrating, stressful, and intimidating. The appeal process is complicated, but we can help. After a written denial, contact an attorney for guidance.
  • Your appeal letter should read like a cover letter to your insurance company. For some, it might be possible to overturn a denial without legal assistance. If a case becomes too complex to manage on your own, you may want to consider seeking assistance from a legal professional.

Dealing With Insurance Coverage Appeals

When writing an appeal letter, refer to the evidence and documents enclosed in your appeal packet, and indicate why this information should change their mind. Although appeal letters vary in style, the format of your letter should include the following:

  • Simply state that you are appealing the decision.
  • Explain why you disagree with the decision.
  • Provide support for your claim. Take this opportunity to explain the history of your eating disorder, (including documentation of all forms of therapy and treatment that you have tried) and the full impact that your eating disorder has had on your life. In your letter, consider including:
      • Summaries of any prior letters or documents
      • Point out the inconsistencies in your insurer’s decision
      • Point out the irregularities in your insurer’s decision
      • Point out the omissions in your insurer’s decision
      • Enclose any new documents
      • Include copies of all medical records
      • Include written support from your providers, family, and friends, and co-workers. Letters from doctors, clinicians, treatment teams, and family members can be a powerful way to display the medical necessity of the treatment for your eating disorder.

    Don’t Give Up

    Too many people are adversely impacted by insurance denials. This can mean additional stress, lapses in treatment, and inconsistency in care.

    Please use the information above as a guide when seeking insurance coverage for the treatment of your eating disorder. The goal is for you to be able to utilize the health benefits to which you are entitled in a way that allows you to access treatment… and focus on recovery.

    Kantor & Kantor is one of the most experienced and highly respected law firms dealing with the prosecution of claims against insurance companies. We represent clients whose insurance companies have failed or refused to pay claims arising out of Disability, Health, Life, Long Term Care and other liability insurance claims.

    If you, or anyone you know has questions about claims against their insurance company, contact us for a free consultation at (800) 446-7529 or visit us at www.kantorlaw.net.

    Page Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on August 24, 2020
    Published on EatingDisorderHope.com, Online Eating Disorder Resources